Risk Factors Associated With Intestine Strangulation In Patients Of Adhesive Small Bowel Obstruction: A Retrospective Study And Follow-up

Objective: To analyze the risk factors of intestine strangulation for adhesive small bowel obstruction patients and follow-up for the treatment results.Methods: A retrospective study was conducted using the database of Gastrointestinal Surgery, First Hospital of Jilin University. Total of 2,430 patients diagnosed as intestinal obstruction between July 2007 and April 2015 were reviewed, finally, 951 patients of adhesive small bowel obstruction were including to analysis.Probable predict risk factors for occurrence of intestinal strangulation were investigated using univariate and multivariate Logistic regression analysis. To get the logistic multivariate predictive model and to evaluate its sensitivity and specificity.Futhermore, the long-term outcome for 398 patients with adhesive small bowel obstruction admitted from January 2013 to April 2015.Results: Ten factors were found closely related to adhesive small bowel obstruction occurred intestine strangulation:operation history,fever(T>37.5 ℃),heart rate increase( > 100/cent),increased WBC count( > 15× 109?L), CT showed intestinal wall density decreases, CT showedthickening of mesenteric swelling,CT showed abdominal cavity effusion,peritonitis,persistent abdominal pains( > 48h),and hypoactive bowel sounds( < 3/cent).Multiariable logistic regression analysis indicated that a total of 7 factors into the Logistic regression equation,respectively,including heart rate increase(>100/cent),increased WBC count(>15×109?L),CT showed intestinal wall density decreases,CT showed thickening of mesenteric swelling,CT showed abdominal cavity effusion,peritonitis,and persistent abdominal pains(>48h).The Logistic regression equation: P=ex/(1+ex), X=-6.358 + 1.223X6 + 2.093X7 + 2.378X18+ 1.746X19+ 1.633X20+ 3.478X21+ 3.006X22.The sensitivity and specificity of the Logistic model were 95.40 %(83/87),71.07 %(614/864).For adhesive small bowel obstruction patients,patients with intestinal strangulation occurred are more likely to recurrence,compare to the simple small intestinal obstruction(41.7%,P<0.001).Patients in the operative treatment groups have less recurrence but more reopreation rate,compare to conservative treatment groups(11.5%,P<0.001). Conclusion: Risk factors associated with intestine strangulation for adhesive small bowel obstruction patients include,heart rate increase(>100/cent),increased WBC count(>15×109?L),CT showed intestinal wall density decreases,CT showed thickening of mesenteric swelling,CT showed abdominal cavity effusion,peritonitis,and persistent abdominal pains(>48h).Compare to simple small intestinal obstruction, patientswith intestinal strangulation are more likely to recurrence. The rate of recurrence and readmission were significantly decreased in the operative treatment groups than that in conservative treatment groups,but more reopreation rate.